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Questo articolo descrive le indicazioni e controindicazioni della biopsia disco-vertebrale, l'esame pre-biopsia, la preparazione del paziente, la scelta del metodo di guida, la tecnica della biopsia e i suoi risultati.

Les calcifications ou ossifications intéressant les parties molles ou la surface des os du poignet, de la main ou des doigts peuvent correspondre à des diagnostics difficiles à établir, plus particulièrement en l’absence de traumatisme évident et peuvent conduire à des examens ou à une surveillance inutiles. Bien qu’il s’agisse principalement de pathologies bénignes qui connaissent une évolution favorable, certains cas nécessitent une résection chirurgicale et/ou peuvent récidiver. En pratique, seules les périostites engainantes paranéoplasiques (syndrome de Pierre-Marie-Bamberger) peuvent révéler une pathologie tumorale maligne, le plus souvent thoracique. Nous proposons d’orienter le diagnostic en fonction de la présentation clinique initiale (douleur aiguë, douleur chronique, tuméfaction±douloureuse) et de l’aspect radiologique.

The radiographic diagnosis of knee osteoarthritis (OA) is based on the presence of a definite osteophyte (OP). Epidemiologic studies and clinical trials commonly employ MRI using standard clinical sequences and OP assessment is one of the features included. Commonly used sequence protocols in such studies are based on triplanar fat suppressed T2- or proton density-weighted sequences with bony features as well as fibrous and lipomatous tissues appearing hypointense. This may potentially result in underestimation of such features including osteophyte assessment. Computed tomography (CT) is considered as the modality of choice for the analysis of OPs and may therefore be considered a reference standard.

The Innovative Medicines Initiative - Applied Public-Private Research enabling OsteoArthritis Clinical Headway (IMI-APPROACH) consortium is an exploratory, European, 5-centre, 2-year prospective follow-up cohort project to combine conventional and new disease markers and to identify different OA phenotypes. IMI-APPROACH was designed to prospectively describe pre-identified progressor phenotypes of patients with symptomatic and/or structural knee OA by use of conventional and novel clinical, imaging, and biochemical biomarkers, and to validate and refine a predictive model for progressor phenotypes based on these markers. Imaging parameters used to assess structural progression include quantitative CT (QCT), X-ray, quantitative MRI and semiquantitative MRI scoring of features of OA.

Complications due to vertebroplasty may be divided into two categories whether or not they are related to polymethylmethacrylate (PMMA) cement leakage from the compressed vertebral body. PMMA leakage is a very frequent occurrence in vertebroplasty is also the main source of complications. Neurological complications are due to cement leakage into the spinal canal and less exceptionally into the intervertebral foramen. The transpedicular needle approach reduces the risk of cement leakage into the foramen. Pulmonary embolism of PMMA may occur when there is a failure to recognize venous migration of cement early during the procedure. Cortical destruction, presence of an epidural soft-tissue mass, highly vascularized lesions, and severe vertebral collapse are factors which increase the rate of complications, which is therefore much higher in metastatic than in osteoporotic vertebral collapse. Prevention of PMMA leakage-related complications is a multifactorial issue including procedure preparation, needle approach and placement, and cement application. The technical refinements which may help reduce the risk of PMMA leakage are reviewed in this article. Experimental data have shown that systemic reactions may occur during vertebroplasty in the absence of cement leakage. These reactions may be partly related to vascular embolism of bone marrow fat. Another controversial issue is a possible increase in the risk of vertebral collapse of adjacent vertebrae following vertebroplasty. Prospective randomized studies are needed to resolve this issue.

La sclérose tubéreuse de Bourneville (STB) est une génodermatose autosomique dominante caractérisée par la survenue d’hamartomes bénins dans différents organes, peau, cerveau, rein, cœur, poumons, œil. Les localisations osseuses de la STB sont fréquemment rapportées dans la littérature radiologique mais sont peu connues des dermatologues. Nous présentons le cas d’un patient présentant une atteinte osseuse de STB à type d’ostéocondensations polyostiques.

The quantification of changes in the trabecular bone structure induced by musculoskeletal diseases like osteoarthritis, osteoporosis, rheumatoid arthritis, and others by means of a texture analysis is a valuable tool which is expected to improve the diagnosis and monitoring of a disease. The reaction of texture parameters on different alterations in the architecture of the fine trabecular network and inherent imaging factors such as spatial resolution or image noise has to be understood in detail to ensure an accurate and reliable determination of the current bone state. Therefore, a digital model for the quantitative analysis of cancellous bone structures was developed. Five parameters were used for texture analysis: entropy, global and local inhomogeneity, local anisotropy, and variogram slope. Various generic structural changes of cancellous bone were simulated for different spatial resolutions. Additionally, the dependence of the texture parameters on tissue mineralization and noise was investigated. The present work explains changes in texture parameter outcomes based on structural changes originating from structure modifications and reveals that a texture analysis could provide useful information for a trabecular bone analysis even at resolutions below the dimensions of single trabeculae.